September 14, 2005
Complications, Diagnosis and Symptoms
Question from Warren, Massachusetts, USA:
My mother is 48 years old. She recently went in to have stents after a stress test. They found that 100% of her main artery is blocked and 70% blocked for the other two. They also found that her arteries are diseased (arteriosclerosis). They couldn’t put a stent in because “the blockage was as hard as this wall, so it’s been there a while.” Her kidneys are also not well. She has hypertension and nerve damage (her hands and feet are always cold). She has seizures from artificial sweetners, had surgery for carpal tunnel syndrome in her wrist and had a slipped disc in her back. She takes insulin.
They gave her a nitroglycerin patch and blood thinners and said she could die tomorrow or in five years. The surgery is too risky. Isn’t there any other alternative to waiting for her to die?
She was diagnosed with diabetes after giving birth to me at 19. Her parents also have diabetes and heart disease, but weren’t diagnosed until 10 years ago. My grandmother also had breast cancer and lost a leg. My grandfather has had a quadruple bypass and is blind. Could my mother of had juvenile diabetes that was never caught? This just seems like alot of damage for such a short period of time. My mother is overweight, over 200 pounds, but not morbidly. I’m 28 and had gestational diabetes with both my kids. I’m not overweight but I’m scared to death that it will hit me from nowhere.
My mother’s diabetes, unfortunately, is very hard to control. Before surgery, she was supposed to take a half dose of insulin but her blood sugar was 70 mg/dl [3.9 mmol/L] so she didn’t. She didnt eat anything and was tested two more times before her surgery. The levels were 90 mg/dl [5.0 mmol/L], then 105 mg/dl [5.8 mmol/L]. What’s going on?
Answer:
The first question you asked has to do with whether there is anything additional that can be done for her heart. This is a judgment on the part of the cardiologists attending to her. Clearly, there are patients with diffuse vascular disease that do not do well because there is nothing to bypass. All the arteries are involved. Surgery would not necessarily help and might be risky to perform. In some of these patients, medical management has been superior to performing surgery. The medical treatment is what is being done. In addition, she needs good blood sugar control, good cholesterol lowering, good blood pressure control, and she needs to reduce her weight. If you are unsure this is correct, you have the option of a second opinion.
Your family has a very strong history of type 2 diabetes. Developing diabetes during pregnancy is a common precursor to developing type 2 diabetes, not type 1 diabetes. You are also at risk. Your best results would be to adopt a healthy lifestyle. This means no smoking, lower cholesterol, no high blood pressure, and frequent medical follow-ups. There have been some diabetes prevention studies done to look at what is the best way to prevent diabetes. The most potent effect came from frequent exercise and maintaining a healthy weight.
It is common to give half of the long-acting insulin before a surgery as surgery itself will increase insulin requirements because of the stress. It also prevents the blood sugar from being very high coming into recovery. The insulin is not necessarily being given to control the pre-surgery blood sugar.
JTL
